| NPI | 1558040824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: ID 61876) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 61876) |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2026-06-02 |